Characterization of treatment failure in HIV positive patients in the Colombian Caribbean region
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Objectives: Treatment failure in patients receiving antiretroviral therapy against human immunodeficiency virus (HIV) is always a concern. The major aim of the present work was to examine the correlates associated with treatment failure in patients living in the Colombian Caribbean city of Barranquilla, an aspect that was poorly studied in this region.
Methods: Treatment failure was evaluated in a cross-sectional study from virological, immunological and clinical standpoints.
Results: It was established that 29.5% of patients under highly active antiretroviral therapy (HAART) could be considered in treatment failure. Among those, virological failure was most frequent (20.9%), followed by immunological- (14.0%) and clinical failure (4.7%). In patients showing lack of adherence to the treatment, the likelihood of suffering from treatment- and virogical-failure were respectively increased by 6.67-fold and 12.19-fold, compared with patients showing good adherence. Although there was no statistically significant association, treatment failure tended to be more frequent in young adults and in patients with low income or low level of education. When antiretroviral therapies (ART) regimens were compared, there was no apparent difference in treatment failure between regimens based on non-nucleoside reverse transcriptase inhibitors and those based on protease inhibitors. This is very important in the context of recent ART strategies, such as early-initiated ART, aimed at achieving long-term infection control.
Conclusions: The current study confirms the importance of treatment adherence to avoid treatment failure and further highlights the importance of educating HIV-infected patients in all parts of the world, especially those individuals with a lower socio-economic status.- HIV
- virological failure
- immunological failure
- clinical failure
- adherence
- antiretroviral therapy
Matthews TJ, Langlois AJ, Robey WG, Chang NT, Gallo R, Fischinger PJ, et al. Restricted neutralization of divergent human T-lymphotropic virus type III isolated by antibodies to the major envelope glycoprotein. Proc Natl Acad Sci USA. 1986;83:9709–13. DOI: https://doi.org/10.1073/pnas.83.24.9709
Llibre JM, Clotet B. Once-daily single-tablet regimens: a long and winding road to excellence in antiretroviral treatment. AIDS Rev. 2012;14:168–78.
Robbins GK, Daniels B, Zheng H, Chueh H, Meigs JB, Freedberg KA. Predictors of antiretroviral treatment failure in an urban HIV clinic. J Acquir Immune Defic Syndr. 2007;44:30–7. DOI: https://doi.org/10.1097/01.qai.0000248351.10383.b7
Cain LE, Phillips A, Lodi S, Sabin C, Bansi L, Justice A, et al. The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study. AIDS. 2012;26:1691–705. DOI: https://doi.org/10.1097/QAD.0b013e328354f497
Easterbrook PJ, Newson R, Ives N, Pereira S, Moyle G, Gazzard BG. Comparison of virologic, immunologic, and clinical response to five different initial protease inhibitor-containing and nevirapine-containing regimens. J Acquir Immune Defic Syndr. 2001;27:350–64. DOI: https://doi.org/10.1097/00042560-200108010-00005
Ferreyra C, Yun O, Eisenberg N, Alonso E, Khamadi AS, Mwau M, et al. Evaluation of clinical and immunological markers for predicting virological failure in a HIV/AIDS treatment cohort in Busia, Kenya. PLoS One. 2012;7:49834. DOI: https://doi.org/10.1371/journal.pone.0049834
Hammer SM, Eron JJ, Jr, Reiss P, Schooley RT, Thompson MA, Walmsley S, et al. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society-USA panel. JAMA. 2008;300:555–70. DOI: https://doi.org/10.1001/jama.300.5.555
Sandström E, Uhnoo I, Ahlqvist-Rastad J, Bratt G, Berglund T, Gisslén M, et al. Antiretroviral treatment of human immunodeficiency virus infection: Swedish recommendations. Scand J Infect Dis. 2003;35:155–67. DOI: https://doi.org/10.1080/00365540310006395
Chang LW, Harris J, Humphreys E. Optimal monitoring strategies for guiding when to switch first-line antiretroviral therapy regimens for treatment failure in adults and adolescents living with HIV in low-resource settings. Cochrane Database Syst Rev. 2010;14(4):CD008494. DOI: https://doi.org/10.1002/14651858.CD008494
World Health Organization. Joint United Nations Programme on HIV/AIDS. United Nations Children's Fund . Epidemiological fact sheet on HIV and AIDS. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2008.
Diazgranados CA, Silva A, Bermudez A, Roncancio D, Dirrugiero P, Mantilla M. Rate and predictors of optimal virologic response to antiretroviral therapy in Colombia. Int J Infect Dis. 2007;11:531–5. DOI: https://doi.org/10.1016/j.ijid.2007.03.002
Jordan MR, La H, Nguyen HD, Sheehan H, Lien TT, Duong DV, et al. Correlates of HIV-1 viral suppression in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam. Int J STD AIDS. 2009;20:418–22. DOI: https://doi.org/10.1258/ijsa.2008.008389
Ma Y, Zhao D, Yu L, Bulterys M, Robinson ML, Zhao Y, et al. Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis. 2010;50:264–71. DOI: https://doi.org/10.1086/649215
Larrea R, Roque M. Manejo del fallo terapéutico a drogas antirretrovirales en el marco de recursos limitados. Rev Cubana Med. 2007;8:46–54.
May SB, Barroso PF, Nunes EP, Barcaui HS, Almeida MM, Costa MD, et al. Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil. Braz J Med Biol Res. 2007;40:551–5. DOI: https://doi.org/10.1590/S0100-879X2007000400014
Liao L, Xing H, Su B, Wang Z, Ruan Y, Wang X, et al. Impact of HIV drug resistance on virological and immunologic failure and mortality in a cohort of patients on antiretroviral therapy in China. AIDS. 2013;27:1815–24. DOI: https://doi.org/10.1097/QAD.0b013e3283611931
Anude CJ, Eze E, Onyegbutulem HC, Charurat M, Etiebet M-A, Ajayi S, et al. Immuno-virologic outcomes and immune-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria. BMC Infect Dis. 2013;13:113–31. DOI: https://doi.org/10.1186/1471-2334-13-113
Ahoua L, Guenther G, Pinoges L, Anguzu P, Chaix ML, Le Tiec C, et al. Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda. BMC Infect Dis. 2009;9:81. DOI: https://doi.org/10.1186/1471-2334-9-81
Sungkanuparph S, Groger RK, Overton ET, Fraser VJ, Powderly WG. Persistent low-level viraemia and virological failure in HIV-1-infected patients treated with highly active antiretroviral therapy. HIV Medicine. 2006;7:437–41. DOI: https://doi.org/10.1111/j.1468-1293.2006.00403.x
Ross MW. Factor affecting information and education, and behavior changes. AIDS Care. 1991;3:419–21. DOI: https://doi.org/10.1080/09540129108251602
Hamers RL, Sigaloff KC, Wensing AM, Wallis CL, Kityo C, Siwale M, et al. Patterns of HIV-1 drug resistance after first line antiretroviral therapy (ART) failure in 6 sub-Saharan African countries: implications for second-line ART strategies. Clin Infect Dis. 2012;54:1660–9. DOI: https://doi.org/10.1093/cid/cis254
Cabrera SE, Santos D, Valverde MP, Domínguez-Gil A, González F, Luna G, et al. Influence of cytochrome P450 2B6 genotype on population pharmacokinetics of Efavirenz in human immunodeficiency virus patients. Antimicrob Agents Chemother. 2009;53:2791–8. DOI: https://doi.org/10.1128/AAC.01537-08
Rakhmanina NY, Neely M, Van Schaik RH, Gordish-Dressman HA, Williams KD, Soldin SJ, et al. CYP3A5, ABCB1 and SLCO1B1 Polymorphisms and Pharmacokinetics and Virologic Outcome of Lopinavir/Ritonavir in HIV-infected Children. Ther Drug Monit. 2011;33:417–24. DOI: https://doi.org/10.1097/FTD.0b013e318225384f
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